Dilated cardiomyopathy associated with checkpoint inhibitor therapy: a case report

Immune checkpoint inhibitors (ICIs) have revolutionized treatment strategies for cancer; however, some fatal cardiovascular immune-related adverse events, such as myocarditis, limit their clinical application. Here, we report a case of ICI-associated autoimmune dilated cardiomyopathy, which has not been previously reported in the literature. A 63-year-old man with hepatic malignancy treated with envafolimab developed heart failure because of envafolimab-induced autoimmune dilated cardiomyopathy. Endomyocardial biopsy revealed a very small amount of lymphocyte infiltration, which was consistent with the manifestations of dilated cardiomyopathy. After the initiation of heart failure therapy according to the 2021 European Society of Cardiology Guidelines for the diagnosis and treatment of acute and chronic heart failure, he was recovering well and discharged. To our knowledge, this is the first case of dilated cardiomyopathy in a patient treated with envafolimab by subcutaneous injection.